C-Spine lecture3

Question 1

abnormal acceleration deceleration of head, neck and torso

Answer 1

whiplash

Question 2

0-50 ms during whiplash

Answer 2

car seatback pushes torso forward, straightening of T and C spine while head remains stationary

Question 3

principle cervical trauma site at 0-50ms

Answer 3

craniovertebral junction

Question 4

75 ms during whiplash

Answer 4

phase with maximal elongation of vertebral artery. s-shaved curve with flexion at the upper levels and hyper extension at the lower levels

Question 5

at 75 ms, physiologic extension limits were exceeded at

Answer 5

the intervertebral levels of C6-T1

Question 6

brain injury with whiplash

Answer 6

when head is thrown back, brain collides with front of skull. opposite happens when head is thrown forward

Question 7

one thing to note about symptoms of WAD

Answer 7

they are highly variable and non specific

Question 8

____ percent of patients will become chronic

Answer 8

20-25%

Question 9

Prognostic indicators for chronic WAD (high evidence)

Answer 9

Elevated initial self reported pain (7/10),
Extreme disability (NDI>40/100)

Question 10

increased sensitivity to ____ is associated with ongoing disability after whiplash

Answer 10

cold

Question 11

low self-efficacy, catastrophizing, lower edu level, reduced ROM, anxiety are all…

Answer 11

associated with ongoing pain after whiplash

Question 12

T/F direction of impact is associated with ongoing pain in WAD

Answer 12

F

Question 13

Grade 0 QTF

Answer 13

No complaint about the neck. no physical signs

Question 14

Grade 1 QTF

Answer 14

Neck complaint of pain, stiffness, or tenderness only. no physical signs

Question 15

Grade 2 QTF

Answer 15

neck complaint AND MSK signs. MSK signs include decreased ROM and point tenderness.

Question 16

Grade 3 QTF

Answer 16

Neck complaint AND neuro signs. Neuro signs include decreased or absent DTR, weakness and sensory deficits

Question 17

Grade 4 QTF

Answer 17

Neck complaint AND fracture or dislocation

Question 18

How long should pts wear a soft collar

Answer 18

for WAD 2 & 3, first 72 hrs (crawford found no benefit in functional recovery

Question 19

Controlled rest

Answer 19

QTF: 1-4 days, WAD II & III

Question 20

Is mm stretching appropriate in the acute phase?

Answer 20

no. because it causes pain

Question 21

When can you progress to mm stretching as tolerated

Answer 21

sub acute phase

Question 22

one sided headache, 4-72 hrs, thobbing

Answer 22

migraine

Question 23

widespread headache, until treated, dull

Answer 23

sinus

Question 24

widespread headache that last for hours, dull

Answer 24

tension

Question 25

one sided, sharp headache that lasts 15 min to 3 hrs

Answer 25

cluster

Question 26

headaches arising from MSK disorders of the c-spine (headband like)

Answer 26

cervicogenic headache

Question 27

3 headache treatment categories

Answer 27

1. c spine manip or mob
2. DNF strengthening
3. UQ strengthening

Question 28

Vertebral artery or vertebrobasilar injury. 5D and 3 ns

Answer 28

Dizziness, drop attacks, diplopia, dysarthria, dyspahgia, ataxia, anxiety, nausea, numbness, nystagmus

Question 29

Acute onset headache “unlike any other” is

Answer 29

a red flag for vertebrobasilar artery disease

Question 30

published contraindications to thrust manips

Answer 30

multi level nerve root pathology, worsening neuro function, unremitting, severere, non-mechanical pain, unremitting night pain (preventing pt from falling asleep), relevant recent trauma, UMN lesions, spinal cord damage

Question 31

The principle of all techniques is that ____ force should be applied to any structure withing the c spine

Answer 31

minimal (low amplitude, short lever thrusts

Question 32

___ ____and ____ form the basis of appropriate tehcnique selection

Answer 32

patient safety, comfort

Question 33

Cervical manips should not be perfomed at the end range, particularly

Answer 33

extension and rotation

Question 34

_______ prior to a manip is good practice to eval pt comfort and to enable eval of their response

Answer 34

positioning the patient in the pre-manip test position

Question 35

Avoid c-spine manip during the ___ ____ of managing a pt with a recent onset of head and neck pain

Answer 35

first week, treat with t spine manp and c-spine ROM

Question 36

T/F if the “unthinkable” happens during a manip, simply manip the other way

Answer 36

F dumbass

Question 37

CPR for neck manip

Answer 37

1. 38 days or less duration of symptoms
2. positive expectation that manip will help
3. difference in c spin rotation ROM to either side at least 10 degrees
4. pain with (PA) testing middle c-spine
   if pt has 3/4 conditions, increases post-test prob of success to 90%

Question 38

history: insidious or acute, inciting events include trauma, emotion, stress, fatigue, posture, hormonal changes, pain pattern is dull and aching, may have pain referred into head, arms, midscap

Answer 38

myofascial pain syndrome

Question 39

Myofacial pain syndrome exam findings

Answer 39

presence of trigger points, mobility loss and mm strength/length (variable), upper crossed syndrome, no neuro findings (if MPS only)

Question 40

what is a trigger point

Answer 40

taut, palpable band, tenderness along band, twitch response with transverse palpation, pain referral with TP palpation

Question 41

C1 fx from axial load

Answer 41

jefferson fx

Question 42

C2 pedicle fx from sudden hyperextension

Answer 42

hangman’s fracture

Question 43

C2 dens fx from combined hyperextension/rotation

Answer 43

odontoid fx

Question 44

lower c-spine spinous process fx from forced hyperflexion

Answer 44

Clay shoveler’s fx

Question 45

general guidlines post-surgical rehab for fracture/dislocaiton

Answer 45

cervical collar 4-6 weeks, walking program, ROM exercise:pt tolerance at 6 weeks, mm strengthening at 8-10 weeks (start with isometrics, progress to isotonics with manual resistance)